Organization
ENT AND ALLERGY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD W LEBERT MD (OWNER/PHYSICIAN)
(337) 312-4355
Entity
Organization
Contact information
Practice address
1615 WOLF CIR, LAKE CHARLES, LA 70605-2348
(337) 312-8681
(337) 312-8682
Mailing address
1615 WOLF CIR, LAKE CHARLES, LA 70605-2348
(337) 312-8681
(337) 312-8682
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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